Provider Demographics
NPI:1598375891
Name:KUDELKO, KATHERINE
Entity Type:Individual
Prefix:MISS
First Name:KATHERINE
Middle Name:
Last Name:KUDELKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8801 LAUREL DR N
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33782-4305
Mailing Address - Country:US
Mailing Address - Phone:727-776-5600
Mailing Address - Fax:
Practice Address - Street 1:8801 LAUREL DR N
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33782-4305
Practice Address - Country:US
Practice Address - Phone:727-776-6850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician